甲癬(大趾趾甲) Tinea unguium (onychomycosis) of the big toenail.
註:這是甲真菌病型: 甲床之遠端和側面真菌病, 感染由角質層或甲皺襞開始,逐漸擴展至甲床和向心性沿趾甲蔓延. 此型總是伴發足癬
Findings: onycholysis, subungual hyperkeratosis, yellow-brown discoloration of keratinaceous debris.
Note: Big toenail onychomycosis type: Distal and lateral subungual onychomycosis (DLSO) – Infection begins in stratum corneum of hyponychial area or nail fold, extending subungually, and progressively involves the nail centripetally and medially. This type always associates with tinea pedis.
This 50 year old man complained of right hand itchy and scaling for half a year. The signs are shown in the above pictures. He has a long history of ‘Hong Kong Foot’. He tried many traditional chinese medicine for ‘Hong Kong Foot’ but was not successful. He is a security guard and he does not have any contact with water or other irritants in his work.
The diagnosis was make clinically. Treatment of this condition is quite difficult because once the condition of his hand has improved (usually 2 weeks of oral antifungal and topical antifungal), he will very likely stop seeing the doctor and stop all the treatments. The condition will recur (re-infection of his hand) soon because the fungi in his toenails and in his feet will infect his hand again.
The patient did not come back for follow up after 2 weeks of medication probably because of the improvement seen in his hand, even though he is warned of the very high chance of relapse of the disease.
手癬–右手真菌感染 Tinea manuum – fungal infection of hand.
圖示僅是右手受累: 彌漫性紅班,角化過度和鱗屑. 50%患者單側受累,而且通常是优勢側.
Findings: Only right hand is involved. There is diffuse erythema, hyperkeratosis and scaling of right hand. More pronounced involvement of palmar creases.
Note: 50% of the patients have unilateral involvement. And usually it is the dominant hand.
皮膚科醫生常見皮膚疾病 – 兩腳一手綜合症(香港手，香港腳)
監督及指導機構 – 英國威爾斯大學/卡的夫大學臨床皮膚專科部門